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Alternative approaches to arthritis treatment

The best evidence to date

Created date

August 24th, 2017
Senior woman dressed in white performing tai chi on a beach.

Tai chi may improve pain, stiffness, and joint function in people with osteoarthritis of the knee.

According to the Centers for Disease Control and Prevention, from 2013 to 2015, an estimated 54.4 million U.S. adults annually had been told by a doctor that they had some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia. 

By far, osteoarthritis (OA) is the most common form of arthritis, as it affects 30 million adults. It can strike any joint in the body, but the most common sites are the hands, hips, and knees. The risk of OA rises with age, and other risk factors include obesity, family history, and being a woman.

“OA is one of the most frustrating problems rheumatologists have to deal with,” says Nathan Wei, M.D., board-certified rheumatologist and clinical director of the Arthritis Treatment Center in Frederick, Md. “While we have symptomatic therapies that sometimes help, our approach to treating this disease hasn’t changed much in the last 50 years or so.”

Standard treatments include anti-inflammatory medication, weight loss if indicated, using assistive devices, and an exercise regimen. Surgery, especially joint replacements, may be necessary for people who have significant joint deterioration. 

In recent years, alternative treatments have been in the spotlight. For the most part, they have not been incorporated into standard treatment recommendations because of conflicting research about their safety and effectiveness.

Acupuncture

Acupuncture is purported to help with pain and disability, according to some studies. Expert sources differ in their guidelines for acupuncture, however. The American College of Rheumatology conditionally recommends acupuncture specifically for knee OA patients who are candidates for knee replacement but who cannot or will not have the surgery. The American Academy of Orthopaedic Surgeons, however, strongly recommends against acupuncture for knee arthritis. “There have been multiple studies with conflicting results for acupuncture,” Wei says. “Nonetheless, some people seem to do well.”

The National Center for Complementary and Integrative Health’s (NCCIH) most recent statement summarizing the scientific evidence is that acupuncture may relieve pain associated with OA. 

Supplements

Dietary supplements such as glucosamine and chondroitin, omega-3 fatty acids (fish oil), turmeric, SAM-e, and bee venom are all being studied. “Glucosamine and chondroitin have been studied intensely with conflicting clinical evidence regarding efficacy,” Wei says. “I prefer to try these compounds instead of using nonsteroidal anti-inflammatory drugs, however, because these supplements are safer. A recent study showed that glucosamine/chondroitin was as effective as celecoxib (Celebrex) as far as pain relief was concerned.”

“Dietary fish oil, flaxseed oil, ginger, garlic, and bromelain all have anti-inflammatory effects,” Wei continues. “Although I generally recommend these for patients with rheumatoid arthritis, I do not recommend them for OA.”

According to the National Institutes of Health, a compound called SAM-e (s-adenosylmethionine) has been shown to be as effective as aspirin for arthritis pain, but it takes about a month to work for most people.

Turmeric has been increasing in popularity. “While it works for some, it does not work for others,” Wei says. “I believe it’s worth trying, though.”

Bee venom comes in injection form. “Research shows that bee venom has anti-inflammatory properties,” Wei says. “Again, some people benefit from it, some don’t.”

Topical treatments include capsaicin, salicylates, menthol creams, and patches. These mainly work by changing the sensation of pain or counteracting it. 

Before trying any supplement or herbal remedy, even topical preparations, check with your doctor. Certain drugs you take may interfere with their effectiveness or have other interactions. 

Mind-body strategies

Tai chi is a martial art that combines gentle exercises with breathing techniques. It has been shown to have a positive effect on balance, and it may improve pain, stiffness, and joint function in people with OA of the knee. Qi gong, another exercise and breathing technique, may have similar benefits, but less research has been done on it, according to NCCIH. While these techniques are generally considered safe, people with OA need to obtain approval from their doctor before trying them.  

Massage therapy is another treatment that has been shown to be generally safe, and it relieves pain and improves function among some people with OA. Once again, however, scientific evidence about its efficacy differs.

Magnets

The use of magnets in the form of bracelets, necklaces, patches, and other devices has not consistently been shown by research to be an effective pain reliever. Some people believe they help, and they are generally safe except for people with some types of implantable medical devices.

There are so many choices when you are investigating relief for OA. Everyone is different, and until there is a cure, a plan for care should be developed with your doctor’s input. “The treatments for arthritis that we have available today are, for the most part, palliative until someone needs a joint replacement as a last resort,” Wei says. “But there are some exciting new developments in arthritis treatment research, including using stem cells to regenerate knee cartilage, and scientists are also studying ways to effectively block the sensation of OA pain.”

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